geiser

I’m not exactly sure how it happened while I was assigned to trauma, but I spent a lot of the day assisting with vascular-type patients. At one point in the ER, there were three or four residents trying to sort out an AV fistula – or rather, a patient with an AV fistula.

The fistula, created and valued for having a lot of blood running through it, fast, under high pressure, had sprung a leak. And such a leak. I’ve seen lots of fistulas oozing persistently, or even enthusiastically. This one gushed continuously, despite a muscular young man having both hands clamped on it; and if anyone let go, it started shooting for the ceiling.

The patient took this all quite calmly, until we were at the most delicate point of trying to get the first stitch somewhere near the hole, which necessarily entailed a lot more blood out of the patient, and all over him and us and the room (in order to see something of where to put the stitch), when he suddenly started moaning and complaining of being cold and dizzy and unable to breathe. Not reassuring.

In the end, we had it sewed up very tightly, it wasn’t bleeding any more, and the patient felt relatively fine. And I have another instance of how being obliged to do something makes you competent. Walking into the room, I wanted nothing more than some senior person to show up and fix everything. But there were no seniors left; they were all in the OR. And from a handful of residents in my year, everyone was looking at me to fix it. So I did.